Provider Demographics
NPI:1982765079
Name:STAFFORD, MAUVALIN CECILLE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:MAUVALIN
Middle Name:CECILLE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:MAUVALIN
Other - Middle Name:C
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:8132 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2000
Mailing Address - Country:US
Mailing Address - Phone:561-228-1330
Mailing Address - Fax:
Practice Address - Street 1:8132 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2000
Practice Address - Country:US
Practice Address - Phone:561-228-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2684232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308597000Medicaid
FLAK337ZMedicare UPIN
FL308597000Medicaid